The Influence Of Factors On Hand Foot Mouth Disease Outcome In The Ⅱ Stage

1.PurposeWe carried out a retrospective study of outcome conditions of the Ⅱ stage hand,foot and mouth disease(HFMD)caused by EV71 infection,analyzed related risk factors,found the independent risk factors and early warning index of the Ⅲ stage severe HFMD and measures to reduce the morbidity and mortality of this disease.2.MethodThe objects of this research are 600 sick children with HFMD treated by Baoding infectious disease hospital during January 1,2013 to April 30,2016.The standard of diagnosis conforms to the “enterovirus 71(EV71)infection in severe cases clinical treatment expert consensus(2011 edition)” diagnostic criteria.All these children with the Ⅱ stage HFMD have been confirmed positive of EV71 infection by Baoding center for disease prevention and control or Baoding infectious hospital.According to the diagnostic criteria,children with HFMD are divided into case group(Group A)in which children turned into Ⅲ phase and control group(Group B)in which children recovered.Group A includes 170 boys(56.67%)and 130 girls(43.33%),while Group B includes 190 boys(63.33%)and 110 girls(36.67%).The average age of Group A is 8.23±5.46 month and of Group B 17.68±6.17 month.After revising in preliminary experiment,a “severe HFMD risk factors questionnaire” has been made by our research group.After related training,investigators collected information of medical records which conformed to the HFMD diagnosis standard and filled the questionnaire.Epidata3.2 software has been adopted to establish the database and SAS 8.0 for data analysis.We use T test method to analyze single factor,and logistic regression analysis for multiple factors.3.Result 3.1 Single factor analysis 3.1.1 Connections between general characteristics of research object and the Ⅲ stage severe HFMDThe general characteristics of research objects includes age,gender,sent to preschools or not,home location and whether having other children in the family.The result of the analysis showed that childcare is connected with the Ⅲ stage severe HFMD,because the proportion of scattered children in Group A(96.67%)is significantly higher than Group B(85%)(OR=25.520,P<0.001).3.1.2 Connection between disease symptoms and the Ⅲ stage severe HFMDRisk factors includes initial symptoms are fever-the highest temperature is over 38.5℃,pharynx isthmus,herpes,vomiting,convulsions and lassitude.Eruption as the initial symptom is protective factor,while cough doesn’t have any statistical significance.3.1.3 Connection between first diagnosis and the Ⅲ stage severe HFMDFor the diagnosis of the first consultation,we found that taking medicine before consultation,going to health clinics in towns and townships for first diagnosis,and having been in village health center are risk factors,while confirmed diagnosis at the first consultation is protective factor.3.1.4 Connection between past medical history and the Ⅲ stage severe HFMDAmong the factors of previous history,only contacting with sick children is risk factor.Connections between the stage Ⅲ severe HFMD and premature delivery,cesarean section or parents’ out-migrantion for work haven’ t been found.3.1.5 Connection between first hospital laboratory test results and the Ⅲ stage severe HFMDIn the first laboratory test results after the patients entered the hospital,we found that risk factors for turning into the stage Ⅲ severe HFMD are PB leukocyte count,neutrophil count and lymphocyte count abnormal,CPR and CK-MB count in serum abnormal,monocyte and polykaryocyte count in cerebrospinal fluid(CSF)abnormal.Other abnormal inspection items don’t have any statistical significance.3.1.6 Connection between the consequence of chest X-ray,ECG,EEG and the Ⅲ stage severe HFMDNo evidence shows that there are direct connection between the chest X-ray,ECG,EEG and the Ⅲ period of severe HFMD.3.2 Multiple logistic regression analysisWe used logistic regression to analyze 15 factors such as “First symptom is fever”.The dangerous factors includes initial symptoms are fever-the highest temperature is over 38.5℃,pharynx isthmus,herpes,vomiting,convulsions and lassitude;first diagnosis came from the village-level medical institutions;contact with sick children;PB leukocyte,neutrophil,lymphocyte,serum CRD,serum CK-MB and other blood index abnormal;monocyte and polykaryocyte count in CSF abnormal.There is only one protective factor,which is being confirmed at the first diagnosis.4.ConclusionDuring the period of HFMD epidemic,the EV71 infection was generally considered as the cause of the local infectious diseases based on the diagnosis results by Baoding center for disease prevention and control or Baoding infectious hospital.The sick children were under 3 years old commonly,whose initial symptoms usually include fever-the highest temperature is over 38.5℃,pharynx isthmus,herpes,vomiting,convulsions and lassitude.First diagnosis at village-level medical institutions or without case confirmation is closely related with the outcome conditions of the Ⅱ stage HFMD.